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usmle hy notes > endocrinology finals > Flashcards

endocrinology finals Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the 4 Diagnostic criteria for DM?

A
  1. H1C >= 6.5%
  2. fasting glucose >= 126
  3. glucose 2h after loading dose >= 200
  4. glucose >=200 in rendom test + glucose symptoms

  • serum glucose need to be confirm with another test in a different day
  • dont check during stress / ilness
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2
Q

What is the A1C target in DM
and what is the glucose level target

A
  1. A1C < 7% (under 6% found to be danger in high risk CV pt)
  2. Glucose level- between 70-180 (fasting glucose 70-130, 2h after meal 180)
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3
Q

3 main side effect of metformin

A
  1. Lactic acidosis (metabolic acidosis)&raquo_space; need to reduce dose in CKD
  2. B12 def.
  3. GI upset- neuasa, vomiting, diarrhea

Weight loss

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4
Q

C/I for mteformin

A
  1. kisney failure (GFR < 30)
  2. HF
  3. Lung failure
  4. other organs failure
  5. Systemic ilness or shock
  6. during IV contrast imaging / major surgery and 48 hrs later
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5
Q

Which DM medications can casue hypoglycemia

A
  • Sulfanulurea
  • Glinides
  • insulin
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6
Q

C/I for glucosidase inhibitors + sulfanylurea + Glinides

A

Renal /liver insuff.

Exp. repglinides- clearne only from liver

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7
Q

GLP-1 side effects

A

pancreatitis

Execpt- Exenatide

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8
Q

DDP-4 inhibitors side effect

gliptins

A

increase risk for Nasopharyngitis and URTI

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9
Q

Which diseases are C/I for the use of GLP-1

A

MEN
or
Medullary thyroid carcinoma

Can increase the prevalnce of Medullary thyroid carcinoma

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10
Q

Which DM medication can asue Urticaria / angioedema and immune mediated dermatological effect

A

DDP4inhibitors

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11
Q

nall of the following are cheracteristics of the DM medication——

Amylin analog, can be use in DM type I and II, loss weight, reduce hyperglycemia after food

A

Pramlinitide

may cause after meal (postprandial hypoglycemia)

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12
Q

which DM medication is beneficial in Pt with Renal disease

A

Thiazolidinediones

Gliterzone suffix

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13
Q

What is the C/I for Thiazolidinediones

A
  1. NYHA III-IV HF

may exacerbate CHF

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14
Q

What are possible Side effect using Thiazolidinediones

A
  1. Reduce bone density
  2. Weight gain
  3. excacerbate CHF
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15
Q

what is the MOA of alpha-glucosidase inhibitors?

Acrebose

A

inhibition of absorbtion of glucose by the intestine

combine with drugs like sulfnyl- can cause hypoglycemia

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16
Q

True or false?

SGLT2i lower episodes of CV event and reccurent hospitalization of CHF

A

TRUE

also reduce risk for diabetic nephropathy

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17
Q

Which DM drug can increase the risk for Euglycemic DKA

A

SGLT2i

glucose < 200

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18
Q

C/I for SGLT2i

A

Renal insuff. (not strat if GFR < 45, no use at all if GFR < 30)

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19
Q

Which DM medication does not effect at all on weight?

A

DPP4i

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20
Q

Which DM medication can be given in hepatic failure?

A

Intecrines (GLP-1, DPP4i), SGLT2i

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21
Q

Which DM medication can not be given in HF?

A

Metformin
TZD (Gliterzone)

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22
Q

How to confirm DKA Dx?

A
  • hyperglycemia
  • Eleveted Serum beta-hydrocybutarate
  • Metabolic acidosis
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23
Q

What is the first Tx of DKA?

A

Fluid replacement:
2-3 L of normal seline or Ringers over first 1-3h

when blood glucose reach to 250 change to 5% glucose and 0.45% seline (prevent hyperchloremic acidodsis)

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24
Q

How to start insulin in DKA, and when to halt the Tx in insulin

A

insulin- 0.1 units/Kg per hour (increase 2-3 folds if no response after 2-4h)

halt when K levels < 3.3- od not administer insulin until pottasium is corrected

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25
Q

Which electrolyte disbalance DKA tx can cause?

A

all the Hypo:
* K
* Mg
* P

26
Q

In which levels of Potassium in DKA a K will be added to the infusion?

A

K < 5-5.2

27
Q

When we will Treat with HCO3 in DKA?

A

**only in Exterme acidosis PH < 7 **

28
Q

What is the main Tx for HHS?

A

Fluid replacment

החזרת נפח נוזלים

29
Q

True or false?

יש קשר סיבתי ברור בין היפרגליקמיה כרונית להיווצרות סיבוכים מאקרווסקולרים?

A

False
הקשר הסיבתי בהיפרגליקמיה היא עם סיבוכים מיקרווסקולרים ולא מאקרו

30
Q

Which vaccination are recommended to all DM pt?

A

Influenza
Covid
Pneumoccoc

31
Q

Whats the target in DM pt regarding their:
LDL , HDL levels
TG
BP

A

LDL < 100, < 70- if CHF or 2 CV risk
HDL ~40-50
TG < 150
BP- like general population (140/90) if theres CV risk (130/80)

32
Q

What is the most common reason for ESRD in the develop world

A

Diabetic nephropathy

33
Q

DM

How many DM pt will develop nephropathy?

and what is the % correlation between nepropthy to retinopathy

A

20%-40% will develop nephropathy

correlation:
DM1- 90%
DM2- 60%

34
Q

What is a major risk factor for developing Diabetic nephropathy?

A

microalbuminurea (30-300)
50% of them will develop macroalbuminurea (>300)
50% of them will progress to CKD to ESRD

35
Q

What is the first Tx when DM pt present with albuminurea?

A

ACEi / ARBS
if C/I then :
diuretics, CCB (non-dhydro = Verpamil/ dilitazem) or BB

if persist:
MRA

DM2&raquo_space; SGLT2i

36
Q

Reccurent episodes of hypoglycemic events in DM pt can lead to———

A

Hypoglycemia associated autonomic failure

damage the counter regulation of glucose (less glucagon when hypo, and less epinephrine)

decrease in awarness to hypo event

can be reverseble if hypo is prevent for 2-3 weeks

37
Q

What is the cumaltive risk for pregnent women with gastetional Diabetic to develop DM?

A

risk of 60% in the following 10-20 years

screening recommended every 3 yrs for womens after Gs .diabetic

38
Q

What is the most common reason for Cushing syndrome?

A

Steroid therapy

39
Q

whats the different between Cushing disease to syndrome

A

Cushing disease is a sub-type of cushing syndrome where theres acess ACTH release from a pituatery adenoma

most common Endogenous reason for cushing

40
Q

Which test can be done to check if cushing is ACTH-dependent vs. independent.

and what will be the further test based on the reasults

A

Check for ACTH levels

High/ normal ACTH- dependent&raquo_space; Hypopyseal MRI
Low ACTH- independent&raquo_space; Adrenals CT

41
Q

How many of the tumors are being missed by MRI of the adrenals?

A

40%

42
Q

which test could diff. between pituatery adenoma to Ectopic ACTH (like SCLC)

A

High dose Dexamethasome test (8mg)

if ACTH supress&raquo_space; Adenoma
If ACTH remain High&raquo_space; Ectopic source

43
Q

What is the main reasons for Hyperaldo?

A
  • primary hyperaldo:
  • 60% Bilateral micronodular hyperplasia
  • 40% Conn’s syndrome (unilateral adenoma)

also rare- Glucocorticoid-remediable hyperaldo- regulate system on aldosterone is by ACTH and not RASS

44
Q

Which medication should be stop before performing Aldo-renin ratio test?

A
  1. Aldactone - after 4 wks w/o
  2. correction of hypokalemia
  3. consider- stopping beta-blockers for 2 wks (may cause FP)
45
Q

What is the tests preform in suspicion of hyper-aldo?

A
  1. Aldo-renin ratio
  2. confirmation test- supress test by seline ingusion/ oral Na loading, fludrocortisone suppresion
  3. non Contract CT of adrenals
46
Q

Which medication are elevate and which depress the ratio between Aldo-renin

A

Beta-blocker- elevate ratio

ACEi + ARB’s- decrease ratio

47
Q

Which workup is rq after incedintiloma > 1 cm?

A

Encodrine workup include:
1. Metanephrins
2. screening for kushing (1st test Dexamethasone test)
3. Renin aldosterone ratio- if HTN present
4. Sex hormones if lesion > 4 cm

sex hormones: 17-hydroxyprogesterone, andriostenedione, DHEAS

47
Q

When we will operate icidentally discovered adrenal mass

A

Hormonal activity
Malignancy

48
Q

what are the 2 finding in imaging that have high suspicion for adrenal malignancy?

A
  1. size > 4 cm
  2. Density > 20 HU
49
Q

What are the main Cherecters of primary adrenal insuff.

Think about which hormones will be defficient

A
  1. Hyperpigmentation- high levels of ACTH
  2. Aldosterone def.- acidosis, hyperkalemia, salt wasting type (hyponathremia) + hypovolemia
  3. Cortisol def.- Weight loss, fatigue, GI symptoms, hypoglycemia, postural hypotension

problem producing Aldo + Cortisol

50
Q

What is the most common primary and secondary adrenal insuff

A

primary- Addison (autoimmune disease)
Secondary- Steroid medications

51
Q

Which melanoma medication can cause Secondary Adrenal insuff

A

Anti-CTLA4 (ipilimumab)

causes hypopyseal autoimmune disease

52
Q

How we diagnose adrenal insuff. ?

until the step of primary vs secondary

whats the steps in the algorithm

A
  1. Sinacten test (ACTH analog)- if Adrenal insuff. present > 4 wks cortisol will not elevate.
  2. Determine if primary or secondary- plama ACTH, Renin aldosterone ratio

Always Check for TSH- hypothyroidism can be a reason for hypoaldo

53
Q

what is the famous triad of pheochromocytoma

A

Palpitation
headache
sweating

54
Q

During surgery of pheochromocytome
how do we stabilize BP?
when it drop or elevated?

A

elevated- Nitroprussid
Drop- fluids IV

55
Q

what is the most coomon reason for Thyrotoxicosis

A

Grave’s disease

56
Q

Which Ab can be found in Grave’s disease

A

Thyroid stimulation immunoglobulins (TSI)

also called TRAb (TSH receptor Ab)

57
Q

Which other Ab can be found in graves , which will not cause a disease

A

anti-TPO
anti- TG

58
Q

all the following can lead to a high suspicious of ————- disease

Pre-tibial edema, purple -red plaques
exophtalmus

A

Grave’s disease

59
Q

Which severe side effect can Mathimazole and PTU can cause

A

Vasculitis
Agrnulocytosis

60
Q
A

usmle hy notes (28 decks)

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